Distally Based Perforator-Plus Sural Fasciocutaneous Flap for Soft-Tissue Reconstruction of the Distal Lower Leg, Ankle, and Foot: Comparison between Pediatric and Adult Patients

Wei, Jianwei; Ni, Jiangdong; Dong, Zhonggen; Luo, Zhuojing; Li, Zheng

doi:10.1055/s-0033-1357274

Cited by 17 publications

(20 citation statements)

References 22 publications

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“…The sural neurofasciocutaneous flap has been a useful and versatile reconstructive option in patients with soft‐tissue defects of the foot, lower leg, and upper limb . It relies on the intrinsic and extrinsic neurocutaneous or venocutaneous vascular supply that accompanies the sural nerve.…”

Section: Discussionmentioning

confidence: 99%

The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect

et al. 2014

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The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects.

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Section: Discussionmentioning

confidence: 99%

The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect

et al. 2014

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“…In our study, the age of each paediatric patient was 12 or less 12 years old, and the average age of the paediatric patients was 6.9 years. In the paediatric population, the perforators originating from the peroneal artery are smaller in absolute size than those in adults [36]. Serletti et al found vessel patterns in adolescent patients (ages between 13 and 17 years), such as size, wall characteristics, and spasm tendency, similar to those seen in adults, and the operative methods did not change compared with those in adults [1].…”

Section: Discussionmentioning

confidence: 97%

“…The survival of flaps included those that completely and those with marginal necrosis. Flaps with marginal necrosis and those with partial necrosis had necrosis lengths less than 1.0 cm and more than 1.0 cm, respectively [36]. The potential risk factors for the flaps included patient factors and flap factors (i.e., width of the skin island, length-width ratio [LWR], location of the top edge of the flap, and so on), which were introduced in detail in a previous study [35].…”

Section: Patientsmentioning

confidence: 99%

Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients

Luo

et al. 2021

J Orthop Surg Res

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Background No large series have analysed distally based sural fasciocutaneous (DBSF) flaps in paediatric patients. The aims of this study were to assess the reliability and analyse the potential risk factors for these flaps and to describe complications in the donor site and the functional follow-up results. Methods Between June 2002 and November 2017, 88 DBSF flaps were used to reconstruct soft tissue defects in paediatric patients. Potential risk factors, reconstruction outcomes, and complications in the donor site of the flaps were analysed. Results Among the 88 flaps, partial necrosis developed in 8 flaps (9.1%). The partial necrosis rate was significantly higher in flaps with the top edge located in the 9th zone (26.1%), with a length-width ratio (LWR) ≥ 5:1 (28.6%), and with a dimension of the skin island ≥ 100 cm2 (22.7%). Partial necrosis did not occur in flaps with a dimension of the skin island < 80.0 cm2 or with a skin-island width < 7.0 cm. The reconstruction outcomes in most paediatric patients were evaluated as “excellent” or “good”. The incidence of obvious scarring was higher in the donor site. Conclusions Partial necrosis of DBSF flaps will significantly increase when the top edge of the flap is located in the 9th zone, when the LWR of the flap is ≥ 5:1, or when the dimension of the skin island is ≥ 100.0 cm2. Flaps with a skin-island width < 7.0 cm or with a dimension of the skin island < 80 cm2 are relatively safe and reliable.

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“…It is important to note that as the pivot point shifts more proximally, the skin island will also be closer toward the popliteal fossa and this can limit the amount of skin available for the flap. Wei et al 18 highlights the differences of the use of DBSF in pediatric and adult patients. We do not have any pediatric patients in our cohort, and therefore we are not able to evaluate if these modifications can also be used effectively in the pediatrics group, and therefore requires further evaluation.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of an Updated and Traditional Surgical Approach of the Distally Based Sural Flap

Cao²,

Kiu-Huen

et al. 2020

J Reconstr Microsurg

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Background The distally based sural flap (DBSF) is one of the armamentarium in the lower limb reconstruction. However, the flap has not gained popularity due to concerns about its reliability and donor site morbidity. Based on the anatomy characterization, we combined and developed five modifications to improve the vascular supply and reduce donor site morbidity. Patients and Methods The authors performed a comparison of retrospective study that included patients who underwent either traditional distally based sural flap (tDBSF) or modified distally based sural flap (mDBSF) surgery approach for ankle, heel, and dorsal foot coverage between January 2007 and May, 2019. The five modifications developed to improve the reliability of the flap include: 1. shift the pivot point more proximally 7.0 cm above the lateral malleolus, 2. preserve the lesser saphenous vein and include branches that communicates with the flap, 3. harvest thinner fascial pedicle, 4. change the skin incision to “S” shape, 5. closure of the donor site with a propeller flap. Results Thirty-one patients underwent mDBSF, and 23 received tDBSF. There were no significant differences in the size of the DBSF. Mean pedicle width was significantly narrower in mDBSF (1.63 ± 0.52 cm vs. 3.81 ± 0.70 in tDBSF). The pivot point was also found to be higher in mDBSF (8.01 ± 0.63 cm vs. 5.46 ± 0.56 cm) above the lateral malleolus. In mDBSF, the size of the propeller flap required for donor site closure was 53.45 ± 19.06 cm2 (range 33–80 cm2). The rate of partial necrosis between mDBSF and tDBSF was significantly different (9.68 vs. 34.78%). While the other complications had no difference. Conclusion The modifications applied to the harvesting of the DBSF have achieved higher survival rate, lower dehiscence rate, and shorter hospital stay time in comparison with traditional approach in our retrospective study.

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Distally Based Perforator-Plus Sural Fasciocutaneous Flap for Soft-Tissue Reconstruction of the Distal Lower Leg, Ankle, and Foot: Comparison between Pediatric and Adult Patients

Cited by 17 publications

References 22 publications

The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect

The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect

Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients

A Retrospective Study of an Updated and Traditional Surgical Approach of the Distally Based Sural Flap

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